Urgent care centers now major health care player north of Boston

Wednesday

May 9, 2018 at 3:06 PMMay 9, 2018 at 3:06 PM

Urgent care centers have exploded around Massachusetts in recent years – and there are several good reasons why.

On a recent Thursday afternoon, physician assistant Adam Rodman stood in an examination room inside the new AFC Urgent Care center in Swampscott’s Vinnin Square and shared how, just moments ago, he had tended to a patient’s lacerated hand.

“She had cut her hand and required several sutures,” said Rodman. “She was here for five minutes before being seen. I evaluated her, and I sutured her lacerated hand – all of which I’ve done in 10 minutes.”

He added, “Now she’ll be home in another five minutes.”

The patient’s entire visit lasted 15 minutes. She walked into the center after attempting to receive care from Salem Hospital Emergency Department, said Rodman.

“She had been sitting in their emergency room for a number of hours,” said Rodman. “She reached out to her primary-care physician’s office, and they recommended that she come here.”

Rodman’s narrative serves as a good example of the type of health care provided by doctors, mid-level practitioners, registered nurses and medical assistants working in the growing number of Massachusetts urgent-care centers.

All urgent-care providers interviewed for this story underscored that patients with chest pain and discomfort, shortness of breath, dizziness, abdominal pain and traumatic injuries, like a gunshot wound, should go directly to emergency rooms.

“We are the largest urgent care provider in Massachusetts with 22 centers,” said Zaka Shafiq, president of AFC’s Beverly and Swampscott locations. “And we have some 122 locations nationwide.” Other AFC centers north of Boston include sites in Malden, North Andover, Saugus and Stoneham.

According to the Urgent Care Association of America, the first centers’ doors swung open in the late 1970s, but they only arrived in Massachusetts within the last decade.

Hospitals, physician groups, community clinics and health-care corporate chains are opening more and more every year as Bay Staters demand more convenient, accessible and affordable health care; there’s a dearth of needed doctors, and the state and insurance companies aim to rein in growing health-care costs.

Massachusetts has witnessed a 740 percent increase in the number of urgent-care centers in the state, from 10 in 2008 to 84 in 2015, according to a 2016 Massachusetts Medical Society article on urgent care’s growth across the commonwealth.

Although Hamilton and Wenham may not have such centers, a handful are just down the road in Beverly and Danvers.

Creating competition

Urgent-care centers across the Bay State now exceed 100, according to Massachusetts Department of Public Health reports. The medical industry’s urgent-care niche has injected competition into the commonwealth’s already competitive health-care economy.

In early January, Lahey Health opened an urgent-care center on the first floor of its outpatient location in Danvers. The town now claims two competing centers. Lahey has also opened an urgent-care center in Gloucester.

“The reason why so many for-profit urgent-care centers are opening is because people want to be seen when they want to be seen, and they are now being seen,” said Hallmark Health System’s chief medical officer, Dr. Steven Sbardella, who works out of Lawrence Memorial Hospital in Medford.

Hallmark operates urgent-care centers in Medford and Reading, said Sbardella.

“We decided to move into an urgent care model after emergency rooms were quite crowded,” said Sbardella.

The Medford-based center opened four years ago, said Sbardella, “right across from the [Medford hospital] emergency room.” More recently, Sbardella said Hallmark’s Reading location opened under the same model – except the hospital staffs it with “well-trained” physician assistants who can “telemedicine” doctors in for assistance should they need it.

Perhaps unique from other centers, Hallmark’s urgent-care professionals spend half their time in the actual ER.

Sbardella said competition has also prompted traditional medical offices to offer nighttime and weekend hours.

Despite the state’s urgent-care growth, the Massachusetts Medical Society says 38 percent of Massachusetts emergency-room visits in 2015 constituted “non-emergency conditions” – and 73 percent of those unnecessary visits occurred after doctor’s offices closed for the day. Centers often do not take appointments, only walk-ins, offering high-quality care for a lower cost and much shorter wait times than emergency rooms.

Non-emergency ER visits represent a significant driver in growing health-care costs because hospitals must charge more to cover costs associated with an around-the-clock staff.

Massachusetts ranks first for the caliber of health-care coverage in the United States, but that comes with a significant price tag. For instance, the MassHealth program – under which one in four Massachusetts residents receive coverage – encompassed 40 percent of the state’s roughly $40 billion budget in fiscal 2017 – compared to 29 percent in fiscal 2009.

“The Health Policy Commission has been examining some of these cost drivers, including avoidable emergency-department visits. The most-recent data published … indicates that 40 percent of all ED visits could be avoided if there was greater access to care,” offered the secretaries in joint testimony before the Legislature’s joint committees on ways and means and health-care financing in a 2017 public hearing.

“One of the ways to control health-care spending is by providing the right care at the right time at the right place,” read the testimony.

A recent Massachusetts Health Policy Commission analysis, which the Massachusetts Medical Society pointed out, reveals ER usage was 30 percent lower in areas in which patients resided within five miles of a retail clinic or urgent-care facility.

Standing in the Swampscott AFC center, Shafiq asked we imagine a patient with a cough who has been waiting in the ER for three hours, and then an ambulance arrives with a patient who’s got a gunshot wound.

“Well, the guy who’s been there three hours will be there for another three hours,” he said. “What else can you do?”

Urgent care takes in patients who should not be in emergency rooms, he says.

“We’re giving them the level of care that’s appropriate to them, their schedule and their budget.”

In return, urgent care is freeing up ERs for what Shafiq described as “more complicated patients.”

“It’s a win-win for patients. It’s a win-win for ER doctors,” said Shafiq, “and it’s a win-win for insurance companies.”

Reporting by Mary Byrne of the Danvers Herald was used in this article.